Risk Tests

Liver cancer

Cancer of the liver is a serious form of cancer. A cancer or tumour of the liver can either start within the liver (called primary liver cancer) or be caused by cancer cells that have come from other parts of the body and spread to the liver (called secondary liver cancer, or liver metastases).

Secondary liver cancer is the more common type in Australia.

Treatment will depend on the type of liver cancer and how much of the liver is affected. Your doctor can advise you about the best treatment options for you.

Primary liver cancer

Primary liver cancer is not common in Australia. It is more common in Africa and Asia, primarily due to the higher rates of hepatitis B infection in those areas.

Risk factors for primary liver cancer include the following.

Chronic (ongoing) hepatitis B or hepatitis C infection. The risk is higher if you have both hepatitis B and C, and higher still if you are also a heavy drinker.

Liver cirrhosis - liver scarring resulting from excessive alcohol intake or disease. Chronic hepatitis B or hepatitis C infection is the most common cause of cirrhosis and primary liver cancer worldwide. Other conditions that can lead to cirrhosis include haemochromatosis (an inherited condition causing progressive iron accumulation in the body, leading to excess iron in the liver cells) and fatty liver. Most people with liver cancer also have cirrhosis.

Smoking.

Eating foods contaminated by toxins called aflatoxins that come from certain types of fungi. Foods such as nuts and grains that are stored in a warm and moist environment may be contaminated by these sorts of toxins. In Australia and other developed countries the amount of aflatoxins in food is regulated.

Other conditions that can increase the risk of primary liver cancer include diabetes, obesity and metabolic syndrome.

Secondary liver cancer

Secondary liver cancer (also called liver metastases) is when a cancer that started in another organ (the primary cancer) spreads and forms a tumour (or tumours) in the liver. Secondary liver cancer is 20 times more common than primary liver cancer in Australia.

Most cancers can spread to the liver, often via the bloodstream or lymphatic system. Bowel cancer is the cancer that most commonly spreads to the liver. Many secondary liver cancers start in organs of the digestive system (bowel, pancreas, stomach) because blood flows from these organs directly to the liver.

Other cancers that can spread to the liver include breast, lung, oesophageal, kidney, and ovarian cancer, and melanoma.

Symptoms of liver cancer

The symptoms for both primary and secondary liver cancer are similar. Liver cancers often do not produce symptoms for some time during their growth. However, symptoms, when they do appear, may include:

jaundice — a yellowing of the skin and eyes;

dark-coloured urine and pale stools;

swelling in the abdomen caused by fluid build-up (called ascites);

abdominal pain that may vary in intensity, especially pain over the liver;

loss of appetite;

weight loss;

weakness and tiredness;

nausea and occasional vomiting;

pain around the right shoulder blade; and

fevers.

Tests and diagnosis - how you detect liver cancer

Your doctor will ask about any symptoms and check the abdomen for signs of liver enlargement. They may be able to feel a hard mass on the right hand side below the ribs if it is enlarged.

There are several tests that may be recommended to check for liver cancer. These include:

Blood tests

A blood test called a liver function test can be done to check the levels of certain substances, including enzymes and proteins, that indicate how healthy your liver is and how well it is functioning.

Blood tests to detect tumour markers (chemicals that are produced by certain cancers) and measure blood clotting may also be recommended.

Imaging tests

A PET-CT scan (positron emission tomography scan combined with a CT scan) may be recommended to help with the diagnosis of secondary liver cancer. This is a special imaging test that can show up cancerous tumours in the body.

Biopsy

A biopsy (tissue sample that is studied under a microscope) may be recommended in some cases. Liver tumour biopsies can be taken through the skin (an ultrasound scan guides the needle to the area to be sampled) or during a laparoscopy - keyhole surgery.

In many cases, liver cancer can be diagnosed using scans and blood tests without the need for a biopsy.

Liver cancer treatment

Treatment of liver cancer depends on the stage of the cancer, which takes into account:

the type and size of the tumour(s);

the general health of the person and their liver health; and

if there is cancer present in any other part(s) of the body.

Your doctor will discuss with you the various treatment options and the risks and benefits of these.

Treating primary liver cancer

Treatment options for primary liver cancer include the following.

Surgery

Surgery may consist of cutting out the cancerous part of the liver (liver resection) or liver transplantation (where the whole liver is removed and replaced with a healthy donor liver). Liver transplantation is a difficult procedure and not all people with liver cancer will be suitable for it.

Surgery offers the best chance of a cure in people with primary liver cancer, but it is not a suitable option for everyone.

Tumour ablation

This is a treatment used to destroy liver tumours, and is one of the most commonly used treatments for primary liver cancer. Tumour ablation can be done using:

thermal ablation (applying heat via radio waves or microwaves passed through a fine needle to the tumour to kill the cancer cells);

Transarterial chemoembolisation (TACE)

This is a procedure that aims to shrink liver cancer or stop its growth by giving chemotherapy directly into a blood vessel that supplies the liver tumour and cutting off the tumour’s blood supply.

TACE involves having a long, thin tube (a catheter) put into a blood vessel in the groin and (under X-ray guidance) threading it through to the main blood vessel that supplies the liver. High doses of chemotherapy are injected into the liver, as well as material that blocks the blood supply to the tumour.

This is one of the more common treatments for primary liver cancer.

Chemotherapy

Chemotherapy can also be given via a drip into a vein (intravenous) or as tablets by mouth. Chemotherapy is sometimes used after surgery to kill off any remaining cancer cells in the body.

Chemotherapy can also be given directly to the liver through a catheter that accesses the main artery to the liver - the hepatic artery. The catheter needs to be surgically implanted.

Radiation therapy

Radiation therapy uses high-energy rays to kill cancer cells.

One type of radiation treatment involves giving high doses of radiotherapy via radioactive beads that are placed in the blood vessel that supplies the liver tumour. This is known as radioembolisation or selective internal radiation therapy (SIRT).

Targeted treatment

A medication called sorafenib (brand name Nexavar) has been developed for the treatment of advanced primary liver cancer. This medicine works by interfering with the tumour’s ability to generate new blood vessels, as well as interfering with certain proteins that help the cancer grow.

Treatment of secondary liver cancer

In the case of secondary liver cancer that has spread from other areas, surgical removal of the affected part of the liver is sometimes possible. However, if there are multiple metastases (secondary tumours) in the liver, surgery may not be effective.

In cases of multiple tumour sites in the liver, treatment may include:

chemotherapy;

targeted treatment - medicines designed to specifically attack certain cancer cells. The choice of targeted therapy would depend on the type of primary cancer (e.g. bowel cancer); or

radioembolisation (also called selective internal radiation therapy) which involves placing radioactive beads in the blood vessel that supplies the liver tumour to deliver high dose radiotherapy.

Your doctor and specialist(s) can advise you on the most suitable treatment for you. Depending on the type of cancer and the stage of treatment, specialists that might be involved in your treatment could include a surgeon, gastroenterologist (specialist in conditions affecting the digestive system), hepatologist (liver specialist) or oncologist (cancer specialist).

Some people may be suitable candidates for a clinical trial, where a new treatment is being trialled to see if it is effective in the treatment of liver cancer. Again, your specialist will be able to discuss the options with you.

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